Overview of Blood Transfusion Therapy
Blood transfusion therapy is one of the important means of clinical medicine, and with the development of blood transfusion technology and the wide application of component blood transfusion, the scope of application of blood transfusion in clinical practice is expanding. Although blood transfusion can achieve better therapeutic purposes, it can also cause some adverse reactions. At present, the rapid development of blood transfusion technology, transfusion reaction caused by blood group incompatibility has been gradually reduced, but non-hemolytic transfusion reaction still occurs from time to time, so we should also pay enough attention to non-hemolytic transfusion reaction, and we should carry out the necessary treatment of blood products and strictly regulate the operation of blood transfusion.
Etiology
Non-hemolytic transfusion reaction is related to gender, recipient’s physical condition, number of transfusions, blood product varieties and other factors.
Symptoms
1. Fever
The most common reaction is fever and chills during blood transfusion. Stopping blood transfusion and treating with antipyretic and analgesic drugs or glucocorticoid are effective.
2. Allergic reaction
During or after blood transfusion, the recipient may have skin changes such as urticaria, angioneurotic edema, etc. In serious cases, generalized rash, laryngeal edema, bronchospasm, anaphylactic shock and other manifestations may occur.
3. Transmission of diseases
Diseases that can be transmitted by blood transfusion include viral hepatitis, acquired immunodeficiency syndrome (AIDS), cytomegalovirus infection, syphilis infection, plasmodium infection, and contaminated blood can cause other pathogenic microorganisms infection.
4. Transfusion-related acute lung injury (TRALI)
It is one of the serious adverse reactions and has a high mortality rate.
5. Ineffective platelet transfusion (PTR)
While increasing the cost of transfusion, it affects the effect of transfusion and jeopardizes the health of patients.
6.Others
Excessive amount of blood transfusion at one time can cause acute cardiac insufficiency, pulmonary stasis and so on. Multiple transfusion of blood or red blood cells can lead to iron overload. Allogeneic transfusion of fresh whole blood (rich in leukocytes) can cause transfusion-associated graft-versus-host disease. Massive transfusions of sodium citrate (ACD) anticoagulated blood or plasma can cause or exacerbate bleeding. Large transfusions of stock blood fashions can cause acid-base imbalance, citrate toxicity, and hyperkalemia.
Examination
Laboratory tests, such as blood routine, biochemistry, electrolytes, coagulation function, infection indexes, etc.; imaging tests, such as X-ray, CT, etc., to find out whether there is a transfusion reaction after transfusion, as well as the type and severity of the transfusion reaction.
Diagnosis
According to the history of blood transfusion, combined with clinical manifestations, laboratory and imaging examinations to determine the existence of blood transfusion reaction, and distinguish its type and understand the severity.
Treatment
Treatment of allergic reaction after blood transfusion: ① Immediately stop blood transfusion, maintain intravenous access with saline, and the remaining blood should not be transfused again. ② Give the patient anti-allergic drugs.
Treatment for fever reaction after blood transfusion: ①Stop blood transfusion immediately and maintain intravenous access with saline. ② Give the patient aspirin. ③Physical cooling can be given to patients with high fever.
Prevention
Blood transfusion is risky, we medical workers should always maintain a high degree of vigilance, strictly grasp the indications for blood transfusion, to avoid unnecessary waste of blood, and reduce the occurrence of adverse reactions to blood transfusion. For those who have been transfused many times or have transfusion reaction, they should be transfused with red blood cells with fewer white blood cells and platelets with fewer white blood cells. If there are conditions, we can do HLA mating or IgA antibody identification, and choose washed red blood cells that are homozygous with the recipient’s HLA, which can reduce the occurrence of transfusion reaction. Meanwhile, with the advancement of medical technology, the use of non-pyrogenic technology for the preparation of blood preservation solution and strict sterilization of blood collection and transfusion apparatus can completely remove the pyrogens in blood transfusion apparatus, so that transfusion febrile reactions caused by pyrogens are almost extinct.